ABSTRACT
This chapter describes the highly problematic introduction of the computerized provider order entry (CPOE) module of an electronic health record (EHR) system at a community hospital, and the successful application of lessons learned to a subsequent implementation at the same hospital. At this hospital, before CPOE was introduced, providers wrote medication orders on paper. These were manually transcribed by pharmacy staff into a pharmacy information system (PIS), which had a unidirectional outbound interface to the hospital’s EHR. Clinicians were able to view patients’ medication lists in the EHR, and nurses used the EHR’s medication administration record capability. In the mid-2000s, the hospital incrementally implemented a new EHR system. The expectation was that clinicians would adopt CPOE readily, making it easier for the pharmacists to focus on clinical review of the medication orders, rather than manual transcription of written orders. Prior to installation of the new EHR, the chief medical informatics officer gave numerous presentations about expectations, especially for mandatory CPOE.
